Summary Report for FSPSAs Ending During the Report Period Center: 02
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs ending between: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1738 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 3 3 13.285714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 13.285714 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 28 30 17.386605 $843.2400 $48.5000
EXIT -EXIT EXIT ASSESSMENT 59 59 61.618049 $3080.9100 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.500000 $582.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.500000 $337.5000 $75.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.183562 $9.3700 $51.0600
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Subtotal (Total Children Is Unduplicated) 88 98 96.188216 $5003.7700 $52.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 62 66.014914 $3300.7500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 4 2.016666 $100.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 15 11.220835 $280.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 217 240 388.647619 $19432.3800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 105 114 173.200003 $8660.0200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.066667 $51.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 19 19 25.700001 $1285.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 202 214 316.561901 $15828.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.900000 $22.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 17 66.038095 $3301.9100 $50.0000
INTR -T1013 INTERPRETER 12 17 49.565079 $2478.2600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 245 426 1640.142847 $16401.4400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 10.000000 $714.4000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 13.571428 $969.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 6.428571 $367.4600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 11.857143 $847.0700 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 231 497 103255.670263 $45948.7700 $0.4500
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Subtotal (Total Children Is Unduplicated) 282 1637 106041.602032 $125027.5900 $1.1800
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Total 1738 106151.075962 $130031.3600 $1.2200
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Number of Children (Unduplicated) With at Least One Authorization 298